This document provides information about breathing related sleep disorders including definitions, symptoms, risk factors, diagnosis, and treatment. It discusses obstructive sleep apnea (OSA), central sleep apnea, and hypoventilation sleep apnea. OSA is characterized by partial or complete collapse of the upper airways during sleep causing breathing pauses. Central sleep apnea involves a lack of breathing effort. Hypoventilation refers to insufficient breathing during sleep leading to high carbon dioxide levels. Diagnosis involves sleep studies and treatment depends on the underlying cause but may include positive airway pressure therapy or supplemental oxygen.

1. AMBO UNIVERSIT
Y
WOLISO CAMPUS
DEPARTMENT:- NURSING
ASSIGNMENT OF PSYCHIAT
RY

3. BREATHING RELA
TED SLEEP DISOR
DERS

4. Outline
1. Definition of Breathing Related Sleep D
isorder
2. Obstructive sleep Apnea
3. Central Sleep Apnea
4. Hypoventilation Sleep Apnea

5. BREATHING RELATED S
LEEP DISORDER
Is general term for breathing difficulties
occuring during sleep.
Is defined as abnormal breathing during
sleep.

6. Obstructive Sleep Apnea
(OSA)
OSA is characterized by apneas and hy
popneas, which are caused by partial
or complete collapse of the upper airwa
ys.
OSA is the commonest of all Breathing R
elated Sleep Disorder and is characterize
d by recurrent
partial or complete collapse of pharynx c
ausing
cessation or impairment of breathing suc
h as

7. During these pauses, an individual’s bre
athing may be significantly reduced or c
ompletely stopped for a period ranging f
rom a few seconds to up to a minute.
These episodes can occur multiple tim
es a night, often leading to fragmented
and non-restorative sleep.
As a result, people with OSA often f
eel unrefreshed and excessively sle
epy during the day.

9. Pathophysiology
Pharynx is abnormal in size or collapsibi
lity.
As an organ for speech and deglutition i
t must be able to change shape and clo
se
As a conduit for airflow it must resist coll
apse

10. Pathophysiology(contd.)
Exact mechanism is not known
During the day muscles in the region keep th
e airway open
During sleep muscles relax to a point where t
he airway collapses to an extent that it gets o
bstructed
Once breathing stops, individual awakens to
breathe and arousal can last few seconds to
a minute

11. Risk factors for OSA
Obesity
Age- middle aged men and post- menop
ausal women
Older age- due to loss of muscle mass
and tone
Family Hx of OSA

12. Symptoms
Insomnia or disrupted sleep
Difficulty concentrating and problems
with memory
Morning headaches
Irritability and mood swings
Waking up frequently at night to urinat
e

13. Signs
Loud Snoring
Witnessed apneas
Obesity
HTN
Metabolic syndrome
Increased Neck circumference
Anatomic Abnormalities

14. Screening for OSA
2 of the three symptoms- EDS, loud Sn
oring, Witnessed Apneas
High Score on ESS(Epworth Sleepiness
Score)>12, or Stanford Sleepiness Sco
re

15. Diagnosis
Nocturnal Polysomnography-in lab stud
y, where EEG, EMG, HR, body position,
leg movements, Oximetry, Snoring, abd
ominal and chest wall movements are r
ecorded
Home studies are limited as EEG is not
recorded, or in some limited studies onl
y Nocturnal Pulse oximetry is done

16. Medical Complications
Uncontrolled HTN
Diminished quality of life from chronic sl
eep deprivation
Increase risk for CVA
Worsening of CAD and CHF

17. Treatment
Behavioral Tx- weight loss
Sleep hygeine
Avoiding alcohol too close to bedtime
Avoid sedatives and hypnotics, narcotic
s
Avoid caffeine

18. Central Sleep Apnea
Is form of apnea in which breathing effor
t is not detected, in contrast to obstructi
ve apnea, in which attempts at breathin
g are vigorous.
Many people are unaware of their nightti
me breathing patterns, so these episode
s of abnormal breathing may go unnotice
d or are only noticed by a partner or care
giver.

19. symptoms of central sle
ep apnea
Tiredness
Fatigue
Lack of energy
Memory problems
Attention or concentration issues
Headaches after waking up
Trouble breathing during the day
Difficulty swallowing
Changes to the voice
Numbness or weakness

20. Does Central Sleep Apnea Cause
Snoring?
Almost everyone snores every once in a
while, and between 28% and 44% of ad
ults snore on a regular basis. Snoring c
an be a sign of sleep apnea, but in most
cases, snoring is not related to an under
lying sleep disorder.
While some people with central sleep a
pnea snore, their snoring is typically les
s severe than in people who have obstr
uctive sleep apnea.

21. Risk Factors for Central Sleep
Apnea
A variety of factors can increase a perso
n's risk of developing central sleep apne
a. For example, CSA occurs more often
in people over 65 years old and in men
and people assigned male at birth. Cert
ain medical conditions that affect breathi
ng also increase the risk of developing c
entral sleep apnea, including:

22. Cont.......
Birth defects
Heart failure
Abnormal heart rhythms
Kidney failure
Hypothyroidism
Stroke
Brain infection
Brain tumor

23. Cont...
Medications and other substances that can in
crease the risk of central sleep apnea or exac
erbate the condition include:
Prescription opioids
Heroin and other illegal opioids
Alcohol
Benzodiazepines
Antidepressants
Seizure medications
Muscle relaxants

24. Diagnosing Central Sleep Apn
ea
To diagnose central sleep apnea, a doct
or often begins by collecting a person’s
medical history, conducting a physical e
xam, and ordering tests to find the caus
e of abnormal breathing. To confirm a di
agnosis, the doctor may also recommen
d a sleep study.

25. Cont......
A sleep study is an important tool for dia
gnosing sleep disorders. During a sleep
study, a person is hooked up to a variet
y of monitoring devices that record breat
hing, heart rate, and other measuremen
ts.

26. Central Sleep Apnea Treat
ment
Treatment for central sleep apnea depe
nds on the cause of the condition.
Positive airway pressure (PAP) therapy: PAP ther
apy includes several different types, including CP
AP, ASV, and BiPAP. These are all methods of d
elivering pressurized air to keep the airway open
during sleep.
Supplemental oxygen: Supplemental oxygen deli
vers extra oxygen to help correct breathing disrup
tions and normalize oxygen levels in the blood. S
upplemental oxygen may be used alone or at the
same time as PAP therapy.

27. Sleep-Related Hypoventilat
ion
is an umbrella term for a group of disord
ers involving insufficient breathing durin
g sleep. This disordered breathing can o
ccur when a person is sleeping at any ti
me of day or night, including while they
nap.

28. Cont......
During hypoventilation, a person’s CO2
levels rise because they do not exhale fr
equently enough. Hypoventilation increa
ses the risks of a heartbeat that is too sl
ow and of insufficient oxygen and exces
s acid in the blood.

29. Common Symptoms of Sleep-Rela
ted Hypoventilation
Insufficient breathing, either too slow or
too shallow, is the key symptom among
all of the different types of sleep-related
hypoventilation. Other symptoms may
occur among several kinds of sleep-rel
ated hypoventilation disorders.

30. Cont......
High carbon dioxide levels: Because hy
poventilation involves slowed breathing,
it can cause high levels of CO2 in the bl
ood.
Low oxygen levels: A common effect of
reduced breathing is insufficient oxygen
in the blood.
Bluish skin: Without enough oxygen in t
he blood, people with hypoventilation m
ay have skin with a blue tinge.

31. Cont...
Shortness of breath: Some people with
hypoventilation disorders experience sh
ortness of breath or painful breathing.
Obstructive sleep apnea and related sy
mptoms: People with a sleep-related hy
poventilation disorder may also have O
SA and experience its symptoms, includ
ing daytime sleepiness, loud snoring, an
d making choking sounds while sleeping
.

32. Causes Sleep-Related Hypove
ntilation
The causes of sleep-related hypoventila
tion vary among its different types. For e
xample, a variation in a gene that affect
s breathing function can cause congenit
al central hypoventilation syndrome and
late-onset central hypoventilation syndr
ome.

33. Cont.....
Certain medical disorders, family patter
ns, and medications can also lead to sle
ep-related hypoventilation. People with
obesity, for instance, are more likely to
have obesity hypoventilation syndrome,
while people whose parents have CCH
S have a higher chance of developing th
at disorder themselves.

34. Diagnosis of Sleep-Related Hypov
entilation
If your health care provider suspects sle
ep-related hypoventilation, they may be
gin by giving you a physical exam and d
iscussing your symptoms.
Then they may suggest testing to confir
m the diagnosis and rule out other disor
ders.

35. Cont.....
Testing usually involves a sleep study,
which reveals details about your breathi
ng and the way your body functions whe
n you sleep.
A sleep study measures brain activity, b
reathing patterns, muscle movement, an
d levels of carbon dioxide and oxygen in
the bloodstream.

36. Treatment
Treatment for hypoventilation often involves tr
eating both the slowed breathing itself and un
derlying issues that may contribute to the con
dition. Your health care provider can help you
determine what treatments are best for your s
ituation.
Positive Airway Pressure In some cases, your
doctor may recommend positive airway press
ure (PAP) therapy as part of your treatment pl
an. PAP therapy requires wearing a mask tha
t provides a stream of pressurized air while y
ou sleep.

37. T
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